Individual provider Active NPI

Matthew Weldon Burttram

  • Registered Nurse First Assistant
  • Tucson, AZ
National Provider Identifier
1629845219
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered Nurse First AssistantTaxonomy code 163WR0006X
License
1-137860 Issued in AL
Practice address
2200 S Houghton Rd
Tucson, AZ 85748-7632
Phone
(520) 543-6100
NPI assigned
Dec 5, 2023
Last updated
Dec 5, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse First Assistant 163WR0006X 1-137860 AL Primary

Addresses

Primary practice location

2200 S Houghton Rd
Tucson, AZ 85748-7632

Mailing address

2200 S Houghton Rd
Tucson, AZ 85748-7632

Other practice location 1

2813 Reserve Ct
Vestavia, AL 35243-2134
Phone (205) 233-0722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1-137860ALMDRegistered Nurse First Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1629845219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 S HOUGHTON RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857487632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 S HOUGHTON RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857487632",
            "telephone_number": "520-543-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2813 Reserve Ct",
            "address_purpose": "LOCATION",
            "city": "Vestavia",
            "state": "AL",
            "postal_code": "352432134",
            "country_code": "US",
            "telephone_number": "205-233-0722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURTTRAM",
        "first_name": "MATTHEW",
        "middle_name": "WELDON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-12-05",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "AL",
            "license": "1-137860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.